Integration between GPs andhospitals: lessons from a division-hospitalprogram

Abstract

The aim of the study reported here was to evaluate current initiatives in GP-hospital integration and highlight areaswhere further research, development and evaluation are required. Seven pre-existing GP-hospital programs wereselected and given supplementary funding to allow for more effective evaluation. These local evaluations were thenincorporated into a national program on GP-hospital collaboration.We found that the seven projects made substantial progress towards their goals, and in the process highlighted importantaspects of successful collaboration. The collective evaluation of DHIP identified expected benefits of collaboration forpatients (improved access to services, reduced anxiety, and fewer post discharge complications), for GPs (increasedinvolvement in acute care and in hospital decision making), and for service organisations (stronger workingrelationships, increased capacity, and greater efficiency). Barriers to service integration were also identified, includingthe different cultures of Divisions and hospitals, their lack of internal coherence and the Commonwealth-state divide.The evaluation showed that much has been achieved in building the relationships and the capacity needed for GP-hospitalcollaboration, and that effective models exist. The current challenge is to extend successful models acrosshealth areas and make effective collaboration part of the normal system of care. Substantial progress towardsintegrated care relies on a shift from a focus on systems within general practice or hospital environments to a patientcentred approach. This will require general practice, hospitals, community services and consumer organisations toform long term partnerships and move beyond their currently disjointed view of acute and community care. Thedevelopment of practical indicators for integrated care will support the process and facilitate shared learning acrossCommonwealth and state divides.